{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T11:17:15Z","timestamp":1762255035027,"version":"3.41.2"},"reference-count":15,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T00:00:00Z","timestamp":1739923200000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Obstet and Gynaecol"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>To investigate if there is any benefit of adding clomiphene citrate (CC)\u2009+\u2009letrozole to controlled ovarian stimulation (COS) cycles on the total gonadotropin dose in POSEIDON group 4 diminished ovarian reserve (DOR) patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 61 DOR patients who underwent 150 COS cycles between 2020 and 2023 in our center were investigated retrospectively. The patients were divided into three main subgroups: group A, group B, and group C. In group A, gonadotropin stimulation started after the completion of 5\u2009days of co\u2010treatment with CC (50\u2009mg twice daily) and letrozole (2.5\u2009mg twice daily). In group B, patients received gonadotropins after completing 5\u2009days of letrozole (2.5\u2009mg twice, daily), and in group C, patients started gonadotropins only.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Mean age was higher in groups A and B. Body mass index, previous parity, and mean AMH levels were similar between the groups. Day 2 antral follicle count was significantly lower in group A (0.90, 1.45 and 1.53; <jats:italic>p<\/jats:italic>\u2009=\u20090.017). The need for gonadotropins was lower in group A compared to groups B and C (<jats:italic>p<\/jats:italic>\u2009=\u20090.131, and <jats:italic>p<\/jats:italic>\u2009=\u20090.029; respectively). Cycle cancellation rates, follicle count on trigger day, number of mature oocytes, number of cleavage stage embryos, and number of blastocyst stage embryos were similar between the groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>CC\u2009+\u2009letrozole co\u2010treatment before starting gonadotropin stimulation in POSEIDON group 4 DOR patients might reduce the need for gonadotropins, with similar live birth rates in COS cycles.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jog.16245","type":"journal-article","created":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T02:48:51Z","timestamp":1740019731000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Comparison of clomiphene citrate + letrozole add\u2010on versus classical ovarian stimulation protocols in diminished ovarian reserve patients"],"prefix":"10.1111","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8646-0619","authenticated-orcid":false,"given":"Mehmet","family":"Tun\u00e7","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility Ba\u015fkent University Hospital  Ankara Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G\u00f6\u011f\u015fen","family":"\u00d6nalan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility Ba\u015fkent University Hospital  Ankara Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,2,19]]},"reference":[{"issue":"7","key":"e_1_2_8_2_1","article-title":"Study of sonographic indicators of ovarian reserves in women with WHO\u2010defined anovulatory disorders","volume":"16","author":"Hans 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multicenter randomized non\u2010inferiority trial","volume":"32","author":"Youssef MA","year":"2017","journal-title":"Hum Reprod"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.12688\/f1000research.10382.1"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2015.05.017"},{"issue":"3","key":"e_1_2_8_13_1","first-page":"285","article-title":"Comparison of the effectiveness of clomiphene citrate versus letrozole in mild IVF in poor prognosis subfertile women with failed IVF cycles","volume":"9","author":"Oktem M","year":"2015","journal-title":"Int J Fertil Steril"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2020.05.026"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.52054\/FVVO.14.1.013"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deaa336"}],"container-title":["Journal of Obstetrics and Gynaecology 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